정신약물에 의한 치명적 이상고열증

이범상 대한신경정신의학회 1983 신경정신의학 Vol.22 No.4

Biological Psychiatry의 최근 동향 : 정서장애의 내분비 계통을 중심으로

이범상 大韓神經精神醫學會 1984 신경정신의학 Vol.23 No.1

과거 10여년 동안에 이룩한 미국내의 정신 신경 내분비학의 발전상과 현황을 논문자료 검토를 통하여 서술하였다. 저자는 특히 HPA를 기반으로 한 DST임상 검사와 그 임상적 적용도와 가치에 관하여 상세한 기술을 시도하였다. 현재 DST는 처음 발표 될때와는 달리 내인성 우울증을 확진 시킬 수 없으며 단지 우울증을 진단하기 애매한 환자군과 감별진단이 극도로 어려운 경우에 내인성 우울증의 진단에 큰 도움을 줄 수 있다는 점이 가장 중요하다고 할 수 있다. 최근 통상적으로 사용되는 DST 검사로서는 오후 11시에 1mg dexamethasone을 투여하고 익일 오후 4시 cortisol 측정만을 흔히 사용한다. cortisol량이 5μg/dl 이하이면 이것을 이상반응(nonsuppression 또는 positive) 이라 규정 짓는다. 또한 DST의 검사 특이도는 처음 약속처럼 높지 못하여 54% 내지 94%이며 그 감도는 28% 내지 32%이다. TRH에 의한 TSH반응의 검사 특히도는 완전하지 못하여 다른 질환에서도 둔마(blunting)를 보이며 그 감도는 약 25%정도이며 이것은 특성 표지로서 간주될 수 있다. 내인성 우울증 환자군에서 성장홀몬 반응에서 이상이 있음을 발견하였고, 과거 10년 동안에 이에 대한 많은 논문이 발표되었다. 이상 열거한 거처럼 현대 정신신경 내분비학 연구결과는 아직 일관성을 보이지 못있고, 많은 논란을 거듭하고 있는 상태이나 앞으로의 끊임없는 연구활동에 의해 확증적인 연구업적이 나올 것으로 기대되며, DST, TSH반응, 성장홀몬 이상반응과 다른 신경내분비의 종합검사를 사용하여 내인성 우울증의 감별진단에 큰 도움을 줄 수 있게 됨으로서 정신과 임상진단의 애매한 허점에 과학적 객관적 검사(objective test)를 가능하게 했다는 점에서 과거 10년동안의 정신신경 내분비학의 발전은 의미가 깊다고 말할 수 있다. The author, in describing some recent advandes in psychoneuroendocrinology, centers on the recent discovery of the Dexamethason Suppression Test(DST), the TSH respones to TRH, and the Gro-wth Hormone(GH) rdsponse in endogenous depre-ssed patients. Lately, it has become certain that the recent advances in neuroendocrinology have encouraged many exciting researches in psychiatry and mor accurate data will probably be available in the near future to further facilitate the corect diagnosis of depression. Althiugh the DST, TSH blunting response to TRH and the GH response in depression do not faciliate the differential diagnosis of depression, they are helpful in differentiating depression from catatonia. Sometimes, the clinical differentiation from catatonia is extremely difficult. The sensitivity of DST is approximately 28% to 32% and its specificity has a large variety from 54% to 94%. The TSH blunting response to TRH is not specific to depression and its sensitivity is about 25% as a trait marker.

정신약물에 의한 치명적 이상고열증

이범상 大韓神經精神醫學會 1983 신경정신의학 Vol.22 No.2

This case of lethal hyperpyrexia is associated with a drug combination of chlorpromazine and benztropine intended to control aggressive behaviors and other psychotic symptoms. A22 year old, single, Caucasian male with a history of mild mental retardation and repeated mental hospital admissions with violent behaviors, developed severe hyperpyrexia while he was exposed to a high ambient temperature (100。F). His body temperatures climbed as high as 108。(42.2。C) and the hyperthermia was followed by cardiovascular collapse, multiple complications (hypostatic bronchopneuinonia and hypoxic encephalomalacia), and finally death. The etiologic considerations, symptomatology, thermoregulatory mechanisms, differential diagnosis, prevertive measures, and the appropriate treatment for the hyperpyrexia were described. The extensive literature review was also discussed in this article. The disease is characterized by sudden, usually unexpected onset, and mortality remains depressingly high. The phenomenon of drug-induced hyperpyrexia has been too little discussed, and there have been too few case reports made regarding this severe illness and its often lethal consequences. However, various neuroleptics, antiparkinsonian drugs, antidepressants and anesthetics have been associated with the disease. The case described in this article may be the first case report of the lethal hyperpyreia with neuroleptic and antiparkinsonian drug combination in the Korean Neuropsychiatric Journal and one of few case reports regarding the drug-induced fatal hyperpyrexia. In contrast to the paucity of the drug-induced hyperpyrexia reports, the disease, while seldom recognized, is not uncommon; this has been previously recognized by several authors. Therefore, the education of mental health professionals, patients, and patient's families concerning the preventive measures, appropriate therapy, and the dangers of using phenothiazine and anticholinergic combination therapy during the summer is special imperative. Acknowledgement: Special thanks to Robert H. Chaney, M.D. at Pomona Valley Community Hospital for supplying detailed medical records regarding the patients' ICU therapy for hyperpyrexia; and Dr. Jon Sramek, Jr. at the USC Dept. of Pharmacology, and Lucille Clippinger, RN for assisting in the article searches.

리스페리돈의 임상 치료 지침

이범상 凡石學術奬學財團 2002 凡石學術論文集 Vol.6 No.-

정신분열증 환자의 가족치료

이범상 凡石學術奬學財團 1999 凡石學術論文集 Vol.3 No.-

클로자핀 치료의 임상지침

이범상 凡石學術奬學財團 2000 凡石學術論文集 Vol.4 No.-

항 우울제의 회귀한 부작용

이범상 대한신경정신의학회 1986 신경정신의학 Vol.25 No.3

Common side effects of antidepressants, particularly tricyclic antidepressants, are the autonomic effects expected as a result of their anticholinergic pharmacological properties: dry mouth, palpitation, tachycardia, loss of accommodation, blurred vision, postural hypotension fainting, dizziness, constipation, vomiting, edema, and aggravation of narrow angle glaucoma, urinary retention. Occasionally, antidepressants also include uncommon side effects such as skin rashes, jaundice, leukopenia or leukocytosis, agranulocytosis, gynecomastia in the male, prolonged ejaculation, disturbed concentration, delirium, hallucination, disorientation, confusional states, nightmares, black-outs, and seizures. An extensive computerized literature search shows that only one article mentions the occurrence of amnestic episodes during antidepressant drug treatment. The author discusses the dissociative episodes with total amnesia and seizures induced by antidepressants using case presentations and also reviews existing articles obtained through computer search. Two cases of the dissociative episodes with amitriptyline hydrochloride and two cases of seizure, one associated with desipramine hydrochloride overdose in a suicide attempt and the other with maprotiline therapy, are discussed and reviewed. Case 1:A 57 year-old divorced caucasian female had a nine year history of severe depression with suicidal ideations. She had had several psychiatric hospitalizations and had been treated with multiple antidepressants, thioridazine, chlorpromazine, and lithium. She started taking amitriptyline 300 mg daily for severe relapse of depression with suicidal risk. Approximately three months later, she developed a fugue state with total amnesia of more than hour-long durations. Her EEG and brain CT scan were all within normal limits. Case 2: A 39 year-old divorced caucasian male had a long history of alcoholism, pancreatitis and depression. He started taking amitriptyline 150 mg daily for depression with sleep disturbance. He responded favorably to amitriptyline and two months later, the dosage was increased to 200 mg daily. Approximately three weeks later, he developed an acute dissociative episode with with violent behaviors. Case 3: A 29 year-old married Korean woman was admitted to a hospital ICU via the emergency room for desipramine overdose. She had ingested about fifty 25 mg tablets of desipramine in a suicide attempt. She had developed acute delusional depression approximately eight months prior to this admission and had been hospitalized in another hospital at that time. She immigrated from Korea to the United States about ten years before her psychotic depression was precipitated by her father’s death. She had a grand-mal seizure while she was in the emergency room and had another seizure in the ICU. Her seizures were treated with phenytoin I.V. injections, and physostigmine I.V. injections were given to counteract the anticholinergic effects of desipramine. She recovered three days later with a complication of mild pleurisy. Case 4: A 32 year-old single caucasian female had suffered from severe depression and anxiety for the past five years. She had tried imipramine and desipramine without favorable response. She started taking maprotiline 50 mg twice a day at her own request because her mother responded well to the same medication. The dosage was increased to 100 mg twice a day, four days later. Nine days later, this dosage was incresed to 100 mg three times daily. She responded well to maprotiline and she was able to work for the first time in five months. Seven days later, she experienced an epileptic seizure at work. She had no past history of epilepsy. Maprotiline therapy was immediately discontinued, and she suffered no further seizures for the following ten months. Acknowledgement: Special thanks to Ofelia Bernier, RN at East San Fernando Valley M.H.S. for

自殺企圖者에 對한 家族들의 態度에 關한 考察 : 二年間의 比較檢討(1965~1966) A two-year comparative study(1965~1966)

尹虎永,李範相 大韓神經精神醫學會 1967 신경정신의학 Vol.6 No.1

This study was designed to investigate the interaction between the attempted suicide cases and their families with special reference to the comparison between the cases of 1965 and 1966. The main subjects for this study were those who had once attempted to commit suicide and subsequently were brought to the receiving room of our Suicide Prevention Center, from the period bewteen Sept. 1, 1965 to Aug. 31, 1966. During this period, the total number of subjects was 213 cases, including 82 males and 131 females. And the subjects compared to the main subjects were those who had previously²²(??) been reported, from the period between March 1, 1965 to Aug. 31, 1965. During this period, the total number of subjects was 194 cases, including 70 males and 124 females. The subjects selected in this study were those to whom we were able to meet the families. They were interviewed by the authors in a general psychiatric interview technique along with the questionaire sheets that had already been made for this particular purpose. Followings were the main results of the study: 1) Incomparison between the two year study reveals few significant deffearences in terms of various aspects we have aimed at, except that, in general, the family's attitude in terms of their concerns and knowledges over the act of suicidal attemptees seems to be improved. 2) The families were mostly consisted of the parents, siblings and spouses and those who have known the patient more than 10 years(79.3%) of period. 3) Total number of the patients who communicated rather clearly of their intents either to their families or someone around them consisted of 27.3%. 4) The family's attitudes regarding the unawareness of the attemptee's serious intent at the time of attempt revealed to be relatively high (50.7%) than it was expected. 5) In the family's attitude toward attemptees at the time of their being noticed from emergency room revealed that 35.7% of the family member expressed that the suicidal act were very serious. 6) In contrast to the relatively low ratio of awareness for the patient's intent before hands, 39.0% of the family member expressed their serious concern over the recovery of their patient while the subjects were under the comastate. This suggests that many were only concerned to the attemptee's emergency care and its recovery than providing preventive measures either befor-hand or the future in this society. 7) Only 20.7% of the family accepted the need for further psychiatric treatment despite the fact that the physician explained to them the need of further care by every possible means. 66.2% of them had frankly denied the needs. The reasons for the objections were mainly of economical difficulties which group consisted of 59.6%. The rest of them had frankly expressed that they did not agree that the cases had anything wrong with their mental condition or else they themselves believed that they can change the minds of the patient. 8) The family's attitudes regarding to the future plan for suicide prevention were relatively vague and unscientific in nature and expressed that they mearly thought things could easily be prevented by simple persuasion, and 26.3% of the families had frankly denied the needs. The reasons for the objection were mainly of ignorance for the needs of the plan (69.7%). These also sugest that the most Korean has only scanty knowledges about the suicidal prevention measurement.

악하선에 발생한 호산성 지방선종 1례

이범상(Bum Sang Lee),이종규(Jong Kyu Lee),장수경(Soo Kyung Jang),서강현(Kang Hyun Seo),김진환(Jin Hwan Kim),방희진(Heejin Bang),이동진(Dong Jin Lee) 대한두경부종양학회 2019 대한두경부 종양학회지 Vol.35 No.2

Oncocytic lipoadenoma is a rare salivary gland tumor composed of adipose tissue and oncocytic epithelial cells in varied proportions. We report a case of an oncocytic lipoadenoma of the submandibular gland, which presented as a submandibular gland mass. The patient was a 65-year-old woman with a right submandibular mass measuring 2 x 2 x 1.6 cm. As a sonographic evaluation and computed tomograph scan gave us the impression of benign submandibular gland tumor such as pleomorphic adenoma, we resected the right side submandibular gland. Grossly, the tumor was well circumscribed with yellow to brown cut surface. Microscopically, the tumor was surrounded by a thin, fibrous capsule and composed of oncocytic epithelial cells admixed with mature adipose tissue. Final diagnosis was an oncocytic lipoadenoma. We discussed here radiologic and pathologic finding of this rare salivary gland tumor.

효율적인 SI 관리를 위한 DataCache Manager 설계 및 구현

이범상(BumSang Yi),임동기(DongGi Im),정민수(Min-Soo Jung) 한국멀티미디어학회 2006 한국멀티미디어학회 학술발표논문집 Vol.2006 No.1

디지털 TV 시스템이란 문자 그대로 비디오, 오디오 및 데이터 등 모든 것을 디지털 처리를 한 후 디지털 전송 방식에 의거 전송하는 시스템을 말한다. 신호는 강력한 전송 시스템을 통해서 방송되고 디지털 신호의 이용자는 셋탑 박스(Set-top Box 또는 디코더)로 디지털 신호를 수신할 수 있다. 이 디지털 신호는, 셋탑 박스에서 방송되고 있는 비디오, 오디오, 데이터를 찾고 그에 대한 상세한 정보를 얻을 수 있기 위해, DVB에서 방송의 전송체계, 내용, 그리고 스케줄 등의 정보를 정의한 규약으로 구성 되어 있는 DVB-SI(Digital Video Broadcasting-Service Information)를 포함하고 있다. 본 논문은 셋탑 박스에 수신된 DVB-SI들을 더욱 효율적으로 관리하기 위하여, 셋탑 박스에 메모리 DB를 이용한 DataCache Manager를 개발하고 많은 양의 데이터들을 빠르고 신속하게 처리할 수 있도록 하였다.